Thursday, March 04, 2010

Institutionalising corruption and malpractise in medical practise

Most senior doctors are quite cynical and pessimistic about our efforts to try to improve the standards of ethical practise in India. They feel that the cancer has become so deeply embedded that trying to remove it will require such heroic surgery that the patient may die in the process !

Tragically, even large corporate hospitals have started giving kickbacks to referring doctors. They have "marketing departments" which pay doctors a "referral fee" which is euphemistically called a "patient management fee". The only management the referring doctor does is to refer the patient to the hospital - and he gets 10% of the hospital bill ! With so much easy money so easily available, is it surprising that doctors are tempted ?

The fact that pharmaceutical companies do this all over the world has been very well documented. Even worse, the scourge has now spread to specialists as well. Cardiologists expect cardiac surgeons to given them a 20% cut for referring patients to them for bypass surgery !

I was talking to a hospital administrator, who was telling me that the reason their superbly equipped operation theater is empty most of the time is that they insist that their doctors collect their patient fees by cheque only. Since the doctors are not allowed to collect cash under the table, they prefer taking their patients to other hospitals !

The fact that the corruption in the medical profession is so widespread is sad. What's even worse is how blithely we all ignore it. We have assumed that this problem is insoluble - and have even given up trying to fix it ! Medical associations do not even discuss the issue because they are scared of offending their own members - after all, who will bell the cat ? Even investigative journalists are not willing to dig deeper and probe the problem !

How will we ever find a solution if we turn a blind eye ? The medical profession needs to heal itself and the best way of doing so is to acknowledge that we have a crisis on our hands which needs to be resolved. Since this is primarily an economic issue, we need to think of ethical ways in which doctors can charge their patients, without having to worry about giving cuts and kickbacks in order to make their ends meet. Based on my personal experience, I feel the best way of doing this is to reach out to patients directly - and the best medium to do this is the internet !

This is why HELP is offering grants to provide free websites for doctors . Millions of patients are already online, looking for good doctors – and we need to ensure that good doctors have an online presence, so it’s easy for patients to find them. We hope these websites will help good doctors to showcase their talent, and will allow them to grow their practice ethically.